Purpose: To analyse how primary diagnosis and complications affect the evolution of post-operative visual acuity (VA). Methods: We performed retrospective chart analysis on 59 eyes in 57 patients with various diagnoses, most of which were non-standard indications for Boston type 1 keratoprosthesis (Kpro) implantation. The follow-up period was at least 3 months. Patients were classified based on the evolution of post-operative VA: group A demonstrated stable VA improvement, group B lost VA improvement and group C no significant VA improvement. Results: We assigned 46% of our cases to group A with stable VA improvement, 32% to group B with lost VA improvement, and 22% to group C with no VA improvement. The number of graft failures before Kpro implantation did not influence VA outcome. Except for the relatively good VA outcome in chemical burn and radiation injury patients, there seems to be no association between primary diagnosis and positive or negative VA outcome. Only 9% of patients with posterior segment complications and 20% with infections and associated pathologies were assigned to group A. Conclusion: Most cases (78%) showed improvement in VA after Boston type 1 Kpro (groups A and B). Posterior segment complications and infections mostly resulted in persistent loss of vision. These complications should be prevented and carefully treated.

1.
Bersudsky V, Blum-Hareuveni T, Rehany U, Rumelt S: The profile of repeated corneal transplantation. Ophthalmology 2001;108:461-469.
2.
Chodosh J, Dohlman C: Indications for keratoprosthesis; in Krachmer J, Mannia M, Holland E (eds): Cornea - Surgery of the Cornea and Conjunctiva. London, Mosby Elsevier, 2011, pp 1689-1691.
3.
Chew HF, Ayres BD, Hammersmith KM, Rapuano CJ, Laibson PR, Myers JS, Jin YP, Cohen EJ: Boston keratoprosthesis outcomes and complications. Cornea 2009;28:989-996.
4.
Bradley JC, Hernandez EG, Schwab IR, Mannis MJ: Boston type 1 keratoprosthesis: the University of California Davis experience. Cornea 2009;28:321-327.
5.
Doane MG, Dohlman CH, Bearse G: Fabrication of a keratoprosthesis. Cornea 1996;15:179-184.
6.
Dunlap K, Chak G, Aquavella JV, Myrowitz E, Utine CA, Akpek E: Short-term visual outcomes of Boston type 1 keratoprosthesis implantation. Ophthalmology 2010;117:687-692.
7.
Yaghouti F, Nouri M, Abad JC, Power WJ, Doane MG, Dohlman CH: Keratoprosthesis: preoperative prognostic categories. Cornea 2001;20:19-23.
8.
Akpek EK, Harissi-Dagher M, Petrarca R, Butrus SI, Pineda R, Aquavella JV, Dohlman CH: Outcomes of Boston keratoprosthesis in aniridia: a retrospective multicenter study. Am J Ophthalmol 2007;144:227-231.
9.
Colby KA, Koo EB: Expanding indications for the Boston keratoprosthesis. Curr Opin Ophthalmol 2011;22:267-273.
10.
Aldave AJ, Kamal KM, Vo RC, Yu F: The Boston type I keratoprosthesis: improving outcomes and expanding indications. Ophthalmology 2009;116:640-651.
11.
Ament JD, Pineda R, Lawson B, Belau I, Dohlman CH: The Boston Keratoprosthesis: International Protocol, Version 2, June 15, 2009. http://www.masseyeandear.org/gedownload!/KPro%20International%20Protocol2.pdf?item_id=5816015.
12.
Zerbe BL, Belin MW, Ciolino JB: Results from the multicenter Boston Type 1 Keratoprosthesis Study. Ophthalmology 2006;113:1779.e1-7.
13.
Durand ML, Dohlman CH: Successful prevention of bacterial endophthalmitis in eyes with the Boston keratoprosthesis. Cornea 2009;28:896-901.
14.
Greiner MA, Li JY, Mannis MJ: Longer-term vision outcomes and complications with the Boston Type 1 keratoprosthesis at the University of California, Davis. Ophthalmology 2011;118:1543-1550.
15.
Schulze-Bonsel K, Feltgen N, Burau H, Hansen L, Bach M: Visual acuities ‘hand motion' and ‘counting fingers' can be quantified with the Freiburg Visual Acuity Test. Invest Ophthalmol Vis Sci 2006;47:1236-1240.
16.
Verdejo-Gomez L, Pelaez N, Gris O, Güell JL: The Boston Type I Keratoprosthesis: an assessment of its efficacy and safety. Ophthalmic Surg Lasers Imaging 2011;42:446-452.
17.
Aldave AJ, Sangwan VS, Basu S, Basak SK, Hovakimyan A, Gevorgyan O, Kharashi SA, Jindan MA, Tandon R, Mascarenhas J, Malyugin B, Padilla MD, Maskati Q, Agarwala N, Hutauruk J, Sharma M, Yu F: International results with the Boston type I keratoprosthesis. Ophthalmology 2012;119:1530-1538.
18.
Goldman DR, Hubschman JP, Aldave AJ, Chiang A, Huang JS, Bourges JL, Schwartz SD: Postoperative posterior segment complications in eyes treated with the Boston type I keratoprosthesis. Retina 2013;33:532-541.
19.
Patel AP, Wu EI, Ritterband DC, Seedor JA: Boston type 1 keratoprosthesis: the New York Eye and Ear experience. Eye (Lond) 2012;26:418-425.
20.
Kang JJ, Cortina MS, de la Cruz J: Visual Outcomes of Boston Keratoprosthesis Implantation as the Primary Penetrating Corneal Procedure. ARVO Meeting Abstracts April 22, 2011;52:341.
21.
Banitt M: Evaluation and management of glaucoma after keratoprosthesis. Curr Opin Ophthalmol 2011;22:133-136.
22.
Kamyar R, Weizer JS, de Paula FH, Stein JD, Moroi SE, John D, Musch DC, Mian SI: Glaucoma associated with Boston type I keratoprosthesis. Cornea 2012;31:134-139.
23.
Talajic JC, Agoumi Y, Gagne S, Moussally K, Harissi-Dagher M: Prevalence, progression, and impact of glaucoma on vision after Boston type 1 keratoprosthesis surgery. Am J Ophthalmol 2012;153:267-274.
24.
Hicks CR, Crawford GJ, Dart JK, Grabner G, Holland EJ, Stulting RD, Tan DT, Bulsara M: AlphaCor: clinical outcomes. Cornea 2006;25:1034-1042.
25.
Trichet E, Carles G, Matonti F, Proust H, Ridings B, Conrath J, Hoffart L: Alphacor keratoprosthesis: device, surgical technique and clinical outcomes (in French). J Fr Ophtalmol 2013;36:393-401.
26.
Jiraskova N, Rozsival P, Burova M, Kalfertova M: AlphaCor artificial cornea: clinical outcome. Eye (Lond) 2011;25:1138-1146.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.